The present invention relates generally to the field of respiratory care systems for intubated patients.
Proper long-term respiratory care of intubated patients requires that a multiple, and often simultaneous, medical procedures be preformed on the patient, including such procedures as, for example, ventilation of the patient""s lungs; aspiration of secretions from the lungs; oxygenation of the lungs; elimination or reduction of residual CO2 from the lungs; visual inspection of portions of the respiratory system; sampling sputum and gases; sensing parameters such as flow rates, pressure, and temperature of gases within the respiratory system; and/or the administration of medication, gases, and/or lavage.
An example of when these procedures need to be simultaneously performed is with patients having low lung capacity, such as premature babies and adults suffering from emphysema. In such patients, it is important to remove secretions which have accumulated in the respiratory system without starving the patient for oxygen during the secretion removal process.
Medical care providers thus need a respiratory care assembly to efficiently and safely permit multiple procedures to be performed simultaneously while minimizing stress to the patient.
U.S. Pat. No. 5,735,271 assigned to Ballard Medical Products describes various adapter assemblies which offer significant advancements in the art. When used with a closed ventilating system, such adapter assemblies can provide multiple access to the respiratory system of an intubated patient.
The present invention improves upon the general type of devices described in the ""271 patent and further addresses the need in the medical field for improved multiple access assemblies for use with closed ventilating systems.
Objects and advantages of the invention will be set forth in part in the following description, or may be obvious from the description, or may be learned through practice of the invention.
The present invention is directed to a respiratory care assembly for use with a closed ventilating system, the assembly providing a plurality of access pathways or ports to a patient""s artificial airway thus allowing uninterrupted flow of ventilating gases to the patient during additional procedures.
The assembly of the present invention includes a manifold for interfacing with the patient""s artificial airway, for example a tracheostomy tube, placed in the patient""s respiratory tract. As used herein, the phrase xe2x80x9cartificial airwayxe2x80x9d includes devices such as tracheostomy tubes, endotracheal tubes, and the like that keep the patient""s natural airway open so that adequate lung ventilation can be maintained. The manifold has a distal port for connecting to the patient""s artificial airway, and a ventilator port for connection to a ventilator to at least partially assist an intubated patient in respiration. The manifold further includes a proximal port that provides access through the manifold to the distal port.
A multi-port adapter is mounted on the manifold in communication with the proximal port and is movable to various operating positions. For example, the adapter may include a movable rotor member that is rotatably mounted to a stationary stator member. The stator member contains an opening or access to the proximal port. The movable component of the adapter includes at least a first and a second access port defined therethrough. The movable component, for example the rotor member, is movable between at least first and second positions such that in the first position the first access port is in axial alignment and fluid communication with the proximal port and the second access port is out of alignment with the proximal port, and in the second position the second access port is in axial alignment and fluid communication with the proximal port and the first access port is out of alignment with the proximal port. The movable member may also be movable to a third position wherein both of the access ports are misaligned or isolated from the proximal port.
The access ports are configured for receipt of any manner of conventional catheter assemblies, cartridges, or similar conduits. These catheter assemblies or cartridges may be releasably connected to the access ports. At least one catheter may be a suction catheter device that includes an inner catheter tube.
The adapter may be moved or rotated such that the access port (i.e., the first access port) mated with the suction catheter assembly is brought into axial alignment with the proximal port of the manifold. The catheter tube within the suction catheter assembly is advanced through the first access port, through the proximal port of the manifold, and ultimately into the patient to allow the suctioning of secretions as described herein. After the catheter tube is retracted, the adapter is rotated such that the first access port is moved out of axial alignment with the proximal port of the manifold.
Similarly, the second access port mated with a second type of catheter assembly may be rotated into axial alignment with the proximal port of the manifold. The second catheter assembly may be, for example, an oxygen supply catheter cartridge having an inner tube for providing additional oxygen to the patient. It should be appreciated that the assembly is not limited to any particular catheter device, and the access ports can be configured to accommodate any type of catheter assembly or cartridge for carrying out a desired procedure through the patient""s airway.
According to one aspect of the invention, the ventilator port may be disposed at an angle such that an axis of the ventilator port is at an angle of more than about 90xc2x0, preferably about 120xc2x0, with respect to an axis of the distal port. This angle allows for better (i.e. more efficient, lower pressure drop) ventilation to the intubated patient and reduces stress on the patient.
According to another aspect of the invention, at least one channel may be formed between at least two of the access ports provided on the movable member of the adapter to place the channels in fluid communication. This configuration allows a relatively small partial flow of air or other fluid between each of the access ports connected by the channel during a suction cleaning operation. It has been found that this flow allows for complete fluid evacuation of the suction catheter or other device during a suction cleaning operation. Furthermore, this flow results in a turbulent flow around the catheter being cleaned, such flow significantly improving the cleaning operation, particularly a lavage cleaning operation of a suction catheter.
For example, a suction catheter assembly mated with the first access port may be in communication with a lavage port provided at the distal end of the suction catheter or formed directly on the first access port. Once the catheter tube has been withdrawn from the patient, it must be cleaned of secretions and mucus. Typically, the cleaning procedure occurs once the clinician has rotated the adapter such that neither the first access port nor the second access port is in axial alignment with the proximal port of the manifold. A lavage solution is introduced through the lavage port and into a distal fitting of the catheter assembly for cleaning the distal tip of the catheter tube during retraction of the catheter tube. In this configuration, the catheter tube will suction the lavage solution from the catheter assembly, carrying at least some of the mucus or secretions that have collected thereon. The cleaning operation occurring in the first access port will cause air or fluid to be sucked through the channel between the first access port and the second access port. This introduction of air or fluid creates greater turbulence about the distal tip of the catheter and aids in the cleaning process of the catheter.
It is important to note that additional access ports may be formed within the movable component of the adapter to allow the connection of additional catheters, conduits, or similar devices to the adapter. In one configuration, for example, four catheters may be connected at four access ports formed in the adapter.
Additionally, according to another aspect of the invention, a seal or gasket may be disposed between the movable and stationary components of the multi-port adapter. A gasket, such as a friction-fit gasket, may be disposed between these components to insure seal integrity and ease of manipulation of the components during operation. The ease of manipulation also provides greater comfort to the patient connected to the manifold.
Moreover, the inclusion of swivels or similar tension reducing devices on some or all of the ports of the manifold may be desired to reduce the torsional effect of twisting of any or all catheters, tubes, other devices connected to the manifold and adapter. The ability to relieve twisting stresses provides greater comfort to the patient and aids in the manipulation of the manifold and adapter assembly.
It may also be desired to provide a grip enhancing surface on the movable component of the adapter. For example, in the embodiment wherein the adapter includes a rotor member rotatably mounted on a stator member, a grip enhancing ring member may be provided on the circumference of the rotor member. The xe2x80x9cgrip enhancementsxe2x80x9d may comprise protrusions, recesses, etc. formed on the ring. This feature enhances the clinician""s ability to rotate the rotor member with respect to the stator member and thus reduces the possible stresses that may be inflicted on the intubated patient connected to the manifold.